Ice breaker questions

Question 1

1. What is Trigger Finger? 2. How will you classify TF? 3. How will you perform a Trigger Finger Release?

Answer 1

1. What is Trigger Finger?

Is inhibition of smooth flexor tendon gliding due to mechanical impingement at the level of the A1 pulley that causes progressive pain, clicking, catching, and locking of the digit.

2. How will you classify TF?

Green classification

Grade I- pain/tenderness at A1 pulley

Grade II- catching of the digit

Grade III- locking of the digit but passively correctable

Grade IV- fixed locked digit

3. How will you perform a Trigger Finger Release?

TRIGGER FINGER RELEASE (PROF. JAMARI)

Indication:

• Release usually done in case of Green’s grade 3 & 4 of triggering
• Grade 1 & 2 will benefit from conservative by physiotherapy and steroid injection, where steroid injection has a better outcome and lower risk of recurrence.

Technique:

• Percutaneous
• Open

Steps:

1. Operation is done under LA by using Lignocaine 2% (need to know the dosage, contra-indications and side effects of it)
2. Make sure to mark which finger to release prior to op (similar like we mark limb by drawing an arrow prior to op)
3. Once patient is given LA, mark the area of incision (if open release)/ point of injection (if percutaneous release).
4. Two things that need to know: i) Line of flexor tendon for each digit (*please refer picture & caption below) ii) For thumb, MF and RF, just follow their mid-axis 🡪 that is how its flexor tendon line is iii) For IF, from the centre point of its MCPJ crease (or also known as proximal digital crease), draw a line towards pisiform 🡪 that is how its flexor tendon line is
5. For LF, from the centre point of its MCPJ crease (or also known as proximal digital crease), draw a line towards scaphoid tubercule 🡪 that is how its flexor tendon is
6. Line of incision for each digit (*please refer picture & caption below)
7. For thumb 🡪 at its MCPJ crease (or also known as proximal digital crease) on top of its flexor tendon line
8. For IF 🡪 at distal palmar crease on top of its flexor tendon line
9. For MF, RF and LF 🡪 at proximal palmar crease on top of its flexor tendon line
10. LA is given at area of incision/ injection based on above explanation. Use small 25G needle (orange), insert it perpendicular to the skin at the previous marked site, and give about 1-2ml of Lignocaine 2%. Observe the LA dispersed side to side.

* then continue the script as below, following what technique that you are being asked or which technique you want to use to answer.